As part of HTN Now June 2021, we spoke to Karl Redmond, NHSE/I Strategic Estates Lead & Secondment at Leeds Teaching Hospital Trust (Digital Smart Buildings & Sustainability), who has 12 years’ experience in real-estate funding and 10 years in academia and architectural practices, as well as international experience in hospital estates.
We discussed smart buildings, sustainability, and changes in culture that will help the construction of new hospitals. He also talked to us about his thoughts on the current state of hospital estates and the opportunities ahead.
To start off, we asked what are the potential problems and what are the opportunities to fix them
The biggest problem is ‘thinking’, we need to widen our thinking when dealing with digital smart buildings. The current structures seem to be made up of many silos with some excellent people in each area, but we need to consider how and what impacts each has on the other. We, therefore, need to breakdown the silos and think holistically. This is not only focused on new builds but also extends to existing assets and estates, as well as patient pathways and clinical resource ability planning.
There are also the traditional working patterns of the construction sector to consider. Capital teams mainly focus on capital projects only, there is nothing wrong with that on the face of it, but we all know the biggest cost for any asset is in the operational phase.
Also, looking under bonnet at existing provider estates and all the many legacy systems / assets they have is crucial. But often [it’s] not seen as a major requirement or priority for the capital teams.
We need to know what works? Is it critical? Do the systems hold critical data? We need to develop strategies so new meets old and vice-versa, seamlessly.
This means letting SMEs in to review what has been developed and some senior people don’t like others reviewing their work. My response would be [that] nobody has all the answers; technology changes and will always impact what has gone before; we will never learn unless we review what has worked and, more importantly, what has not; SMEs are not there to point the finger, they are there to help with what comes next.
What new innovations can we use in future hospitals to improve efficiency and productivity?
Real-time data feeds updating static data periodically, via the capture of active data, all of which can be linked to digital twin arrangements and analytical requirements and insight development – depending on what the client wants.
This can relate to existing estates, as well as new builds, and can be approached by the client by considering a number of areas, such as prioritisation, functionality needs, modularisation of the requirement; and [then] linked to the principles mentioned previously.
If the approach is followed, it will also help with the management of the smart digital building programme, which will help with the financial management of the implementation plan.
This, in turn, will provide transparency and give confidence to those controlling the purse-strings, as well as wider stakeholders such as clinicians, senior managers and politically-oriented types. This kind of offering will help with monitoring and measurement of a wide range of needs (E&FM, sustainability, equipment and people tracking; predictive maintenance; improve procurement efficiency; financial management, supply chains and more).
It really does depend on what the client wants – it can be developed and advanced on a ‘start small, think big, scale fast’ basis, so various groups can be comfortable about the monetary and non-monetary benefits available.
What lessons can we learn from our current hospital system that we can use going forward?
That digital technology is not the answer but is a significant enabler to aid better patient pathway improvements, help under-pressure clinical resource, improve and extend the lifecycle, durability, safety, performance and efficiency of the healthcare estate.
We also need to remember that change is not bad, and nobody has all the answers. Not even the entire workforce of the NHS has all the answers, so bring in the SMEs rather than go down the ‘emperor’s new clothes’ route because it is convenient.
Finally, please keep in mind this will not be easy and you will all need to support each other with changes in thinking and culture.
How important is sustainability in designing the future of hospitals?
I believe it is a high priority and there is a lot of good work being developed by some very good people – although, I believe we need to be better at linking in the digital expertise that will help measure and provide robustness, granularity, and consistency, to the aspirations the healthcare system has to sustainability.
Digital can help with the ‘how’ and through digital measurement and monitoring can help improve, year on year, the carbon footprint as well as create efficiencies. There are SMEs engaged in digital programmes who will be a part of the UN COP26 conference, explaining how and why digital can help with the sustainability agenda. Digital just needs a bigger voice in the healthcare system and for others to let it be a part of the agenda via SMEs.
Is sustainability gaining attention in healthcare?
There is a shortage of consistency and ideas on how we implement plans and tackle the various areas that fall under the sustainability agenda. As with all changes, it will take time and money, so I would repeat the message above – prioritise where you (the client) want to start, allow digital SMEs to help you with the granular ‘bottom up’ measurement programme, and gather what data you currently have and link it with whatever data you don’t have that can be captured by the digital experts.
It is the ‘start small, think big and scale fast’ approach mentioned earlier, which gives the client control on size, scope, cost, speed of implementation etc. The expertise is there in the form of digital SMEs, as mentioned previously, if they are off to the United Nations COP26 conference, and have links with academic research programmes, as well as the International Standards Organisation, they must be doing something right. We just need to capitalise on that thinking and know-how, which means looking outside of the usual suspects as well as outside of the NHS, when required.
What aspect of smart buildings do you see as a ‘game changer’?
It really doesn’t matter what I think will be a game changer, each client will have a different view and requirement, all are important.
Although, the ability to link vast amounts of static and active data into a model (digital twin) that can be viewed and understood by all and drilled down on by looking at the model through a different set of spectacles, so to speak, is very exciting for anyone.
The clients could have their entire physical operation, occupants and supporting needs all recognised in one location, which means the client can change and implement plans with the ability to assess the impacts (good or bad), via the data gathered, and [it] will be specific to their needs.
The ability to link traditionally siloed data sets and carry out analysis on what you want and need as well as develop insights for others to learn from and improve is also very exciting. It is all deliverable, manageable and controlled by the client, we just need to know where the client wants to start, what they have in place and where is they want to go.
Is innovation enough of a priority for the Department of Health and Social Care?
Yes – but we need more detailed guidance – especially around smart buildings – I don’t think the size, scope and reach of smart buildings is fully understood, which in turn limits the thinking of providers. We need more detail from the centre for providers to follow and as prompts for each to consider when engaging with the market – prompts that will push them in to investigating further the ‘art of the achievable/possible’.
This will also help when developing client briefs that will be issued to the market – we need to avoid expensive, proprietary systems that sometimes look easy and convenient to implement day one on the face of it, but are more often than not leading the healthcare provider down a very costly and long-term road, which they can’t escape from.
As for being a ‘priority’, I think it is trying to get a place at the table, unfortunately, and in some instances – rightly – there are a number of competing voices that don’t want digital interfering with traditional thinking and programmes. There is a degree of uncertainty and fear, coupled with a view that all things digital are expensive and will go wrong.